Will physicians replace MHAs?: reflections from Australia

Tom Weil, in the preceding article, sees the physician executive playing an increasingly significant role in negotiations between payers and service providers, in offering the public acceptable explanations for the inevitable changes in the provision of care, and in developing more cost-effective methods of delivering high-quality health care at affordable prices. Effective involvement of physician executives will be facilitated by their having received professional training somewhat different from that of the traditional MHA. How do these prognostications relate to the health care scene in Australia? Factors that must be taken into account in considering their applicability to Australia include differences in the structure and management of the Australian health care system, the current state of that system, the background of the leadership that makes the key managerial decisions in the Australian system, and emerging trends within the system.     

Real executives make career moves. Will you?

Not all physician executives have accepted the career move as a key part of executive life. They prefer to stay put and they often do just that. While clinicians may have the luxury of choosing a single geographic location and remaining there through retirement, physician executives often have to reorder their priorities to give the position greatest significance in career decision-making. Spouses and families need to be educated to the new reality of executive life--sometimes, to support an important career opportunity, a move is required. Physician executives unwilling to make career moves limit their career potential.     

Can physicians lead other physicians into the future?

This article reflects upon some of the dynamics that prevent physicians from successfully engaging change. Physicians are enculturated to the competitive and hierarchical, and to value personal autonomy. These traits promote distrust and inhibit the formation of collaborative relationships. At this time of growing complexity, when most other industries are developing styles of work based on teamwork, worker empowerment, cross training, and information sharing, physicians cling to the metaphor of the ship's captain, a lone decision-marker and authoritarian possessor of grand knowledge. And yet, in order to lead, physicians need to learn to work differently and nurture a more collaborative approach. The author's blueprint for change includes: Stop trying to manage consensus; commit to measured accountability; think systemically; don't make the mistake of thinking that people will follow because you are right; and, most importantly, create relationships based on shared purpose and principles.     

Community health information networks. Threat or opportunity in the doctor-patient relationship?

The last half of the 20th Century has been witness to numerous changes in the delivery and financing of health care services. These changes have impacted the one-to-one doctor-patient relationship that may have existed in the past to become a complex of relationships. The contemporary physician collaborates with many other professionals to assist in the delivery, financing, and monitoring of health care services. These clinicians and other professionals require access to patient information to deliver care and secure payment. The patient understands this. Yet the patient has concerns about the widening circle of persons authorized to access his or her information. These concerns have been amplified by the development of community health information networks--(CHINs). This article focuses on CHINs, both patient concerns and the role physicians can take in developing them.     

Attracting qualified physicians to underserved areas. Part 1: Why has the U.S. experienced such difficulty?

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are: supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part 1 of this article reviews the efficacy of these approaches, while the second part, which will appear in the January/February 1999 issue, explores a more pragmatic option: to simply improve the working conditions and just pay substantially more to physicians who practice in "less desirable" locations.     

Who supports physicians in malpractice cases?

Malpractice suits have a devastating emotional impact on physicians. Learn about a unique service offered by the HealthTexas Provider Network to help doctors deal with the shock and sadness.     

How should managed care physicians be paid?

When paying a physician for medical or surgical services, most patients expect the traditional bill or charge for that encounter or visit. While most people also pay health insurance premiums, few patients expect to prepay for their health care. But that is the foundation of most managed health care systems-prepaid medicine. PPOs, IPAs, and HMOs are typically health care providers linked together to provide services to a set population for a specific prepaid fee or "capitation" payment. Other providers contract with these managed care insurers to receive a predetermined and often "discounted" professional fee for services. These managed care organizations have already gone through a number of stages in determining how physicians are to be compensated for their services, and further changes loom on the horizon.     

Can you take your soul to work?

David White in The Heart Aroused: Poetry and the Preservation of Soul in Corporate America explores ways for professionals to take their souls to work, instead of checking them at the door. "We simply spend too much time and have too much psychic and emotional energy invested in the workplace for us to declare it a spiritual desert bereft of life-giving water." Several ideas are presented to help physician executives preserve their souls in an increasingly corporatized U.S. health care system: (1) Figure out what you are meant to do as your life's calling; (2) know what you think and want; (3) share some of what you think at work, while being careful to not lose your job unless you choose to; (4) be a trustworthy listener and find one; (5) get yourself outside; (6) pay attention to your physical space; and (7) develop some new hobbies or refresh old ones. "One of the disciplines of building a rich soul life seems to be the simple act, on a daily basis, of remembering what is most important to us."     

Will More Purchasing Options Benefit Customers?

This paper considers the sale of a seasonal product in the face of strategic customers. At the beginning of the selling season, the retailer announces both the price p_h at which the product will be sold during the selling season and the post‐season clearance price p<p_h for unsold items. We analyze two operating regimes: The “no reservation regime” allows a buyer either to purchase the product at price p_h when he arrives or to enter a lottery to purchase at price p if the product remains unsold. The “reservation regime” offers each buyer one extra option than the no reservation regime: reserve the product for purchase at the clearance price p. If the buyer reserves the product under the reservation regime and if it remains unsold at the end of the selling season, then he is obligated to purchase it at price p. We consider a situation in which heterogeneous customers with probabilistic valuation arrive in accord with a Poisson process. We characterize the rational purchasing behavior wherein each arriving customer is strategic; each customer takes other customers' purchasing behavior into consideration. By considering the Nash equilibrium of this game, we show that strategic customer behavior can render the customer to be worse off and the retailer to be better off under the reservation regime, despite the fact that this regime offers one extra option (reservation) to a customer. Hence, more purchasing options do not necessarily benefit customers.     

Will your academic department survive managed care?

The current form of academic department is likely to vanish from many institutions. Changes occurring in health care are part of the evolution other industries have experienced, following the product life cycle. Physicians are becoming "deprofessionalized" and as such are beginning to resemble technical workers seen in other industries. The rearrangements in health care are bringing together organizations with different missions, priorities, culture and even language. An academic department may not be considered as an asset to the larger organization or network, representing but one option for product differentiation in the market place. There are strategies for maintaining the viability of the academic component of an organization that necessitate congruence with the overall strategy for the greater organization.     

Will retiree health benefits survive FAS 106?

Recent months have seen dramatic public announcements about retiree health care coverage. General Motors recorded a $24 billion quarterly loss this year, due almost entirely to a one-time charge for future retiree health care costs. Other major employers have also reported sudden staggering losses, along with plans to decrease or stop retiree health coverage entirely. Some of these companies have been taken to court. The headlines also identify a culprit--an obscure accounting requirement, Financial Accounting Standard 106. To understand how an accounting rule can have such a profound effect on both the health care of our seniors and the financial strength of American industry, it is necessary to understand how employers pay for their retirees' care, how new accounting rules governing these costs can threaten a company's survival, and how employers are changing their employees' health coverage to meet these threats.     

Why will physicians in this new environment replace MHAs?

The competitive forces of managed care, capitated payment, cost constraints, and the formation of health networks are among the major precipitating factors leading to the employment of additional executives and middle managers with clinical backgrounds. These factors will require our health leaders to know how to cut costs without seriously impinging on the accessibility and quality of patient care. Physicians with leadership and management skills, and with prior hands-on patient care expertise, will continue to be sought after in the foreseeable future by various types of health organizations. With this scenario, health services management generalists are predicted to experience increasing difficulties to secure senior positions in the health industry,     

Hamiltonian numbers of M?bius double loop networks

For the study of hamiltonicity of graphs and digraphs, Goodman and Hedetniemi introduced the concept of Hamiltonian number. The Hamiltonian number h(D) of a digraph D is the minimum length of a closed walk containing all vertices of D. In this paper, we study Hamiltonian numbers of the following proposed networks, which include strongly connected double loop networks. For integers d≥1, m≥1 and ?≥0, the M?bius double loop network MDL(d,m,?) is the digraph with vertex set {(i,j):0≤i≤d?1,0≤j≤m?1} and arc set {(i,j)(i+1,j) or (i,j)(i+1,j+1):0≤i≤d?2,0≤j≤m?1}∪{(d?1,j)(0,j+?) or (d?1,j)(0,j+?+1):0≤j≤m?1}, where the second coordinate y of a vertex (x,y) is taken modulo m. We give an upper bound for the Hamiltonian number of a M?bius double loop network. We also give a necessary and sufficient condition for a M?bius double loop network MDL(d,m,?) to have Hamiltonian number at most dm, dm+d, dm+1 or dm+2.     

What do we loose when machines take the decisions?

This paper concerns the technical issues raised when humans are replaced by artificial intelligence (AI) in organisational decision making, or decision making in general. Such automation of human tasks and decision making can of course be beneficial through saving human resources, and through (ideally) leading to better solutions and decisions. However, to guarantee better decisions, the current AI techniques still have some way to go in most areas, and many of the techniques also suffer from weaknesses such as lack of transparency and explainability. The goal of the paper is not to argue against using any kind of AI in organisational decision making. AI techniques have a lot to offer, and can for instance assess a lot more possible decisions—and much faster—than any human can. The purpose is just to point to the weaknesses that AI techniques still have, and that one should be aware of when considering to implement AI to automate human decisions. Significant current AI research goes into reducing its limitations and weaknesses, but this is likely to become a fairly long-term effort. People and organisations might be tempted to fully automate certain crucial aspects of decision making without waiting for these limitations and weaknesses to be reduced—or, even worse, not even being aware of those weaknesses and what is lost in the automatisation process.